Showing papers in "iranian journal of nursing and midwifery research in 2014"

Professional socialization in nursing: A qualitative content analysis.

Abstract: Background: Being a nurse is more than just a series of business activities and skills. In fact, it is a part of the process of socialization, which is internalization and development of professional identity. Professional socialization is necessary for involving the students in professional practices. Thus, the purpose of this qualitative research was to increase the understanding of professional socialization in nursing and explore the related factors from the perspective of registered nurses and nursing students. Materials and Methods: In this qualitative design, data were collected on 43 nurses with a variety of experiences using semi-structured interviews and focus groups in the Shiraz University of Medical Sciences in 2012. Data were analyzed through inductive content analysis. Results: The data analysis revealed two main categories: (1) sense of belonging with three sub-categories of theory-practice incongruence, educational experiences and tacit knowledge and (2) forming professional identity consisting of three sub-categories of relatedness, internal motivation and role model. Conclusions: This study demonstrates that in nursing, sense of belonging and professional identity contributes to professional socialization; it is suggested that these factors, which improve socialization in nurses, be taken into account by authorities.

Nursing professionalism: An evolutionary concept analysis

Abstract: Background: Professionalism is an important feature of the professional jobs. Dynamic nature and the various interpretations of this term lead to multiple defi nitions of this concept. The aim of this paper is to identify the core attributes of the nursing professionalism. Materials and Methods: We followed Rodgers’ evolutionary method of concept analysis. Texts published in scientifi c databases about nursing professionalism between 1980 and 2011 were assessed. After applying the selection criteria, the fi nal sample consisting of 4 books and 213 articles was selected, examined, and analyzed in depth. Two experts checked the process of analysis and monitored and reviewed them. Results: The analysis showed that nursing professionalism is determined by three attributes of cognitive, attitudinal, and psychomotor. In addition, the most important antecedents concepts were demographic, experiential, educational, environmental, and attitudinal factors. Conclusion: Nursing professionalism is an inevitable, complex, varied, and dynamic process. In this study, the importance, scope, and concept of professionalism in nursing, the concept of a beginning for further research and development, and expanding the nursing knowledge are explained and clarifi ed.

Compassion fatigue and burnout in Iranian nurses: The role of perceived social support

Abstract: A BSTRACT Background: Nurses are at risk for symptoms of compassion fatigue (CF) and burnout (BO). Social support plays an important role in predicting CF and BO. This study was performed to determine the prevalence of the symptoms of CF and BO and the role of perceived social support in predicting these symptoms in Iranian nurses. Materials and Methods: Using a correlational descriptive survey research design, we selected 173 participants among the nurses working in public hospitals of Malayer, Iran. Professional Quality of Life (CF and BO subscales) and Multidimensional Scale of Perceived Social Support (MSPSS) were used for collecting the data. Results: The obtained results indicated that the prevalence of CF and BO symptoms was 45.3% and 15.03%, respectively, in Iranian nurses. Social support (signifi cant other, family, and friends) was negatively correlated to BO ( P < 0.01). Also, there was a negative correlation between social support from family and CF ( P < 0.01). According to hierarchical multiple regressions, social support from family was the signifi cant predictor to CF ( P < 0.005) and BO ( P < 0.001) in nurses. Conclusions: Based on the obtained results, some nurses (especially emergency nurses) are at risk for CF and BO and social support negatively correlated to CF and BO in Iranian nurses. It is necessary to develop support systems for nurses who are at risk for CF and BO. Key words: Burnout, compassion fatigue, Iran, nursing, social support

Nursing students’ spiritual well-being, spirituality and spiritual care

Abstract: Background: Spiritual care should be considered an important part of holistic and multidisciplinary care and it has not been given much importance so far. We should begin with student nurses, who will soon be clinicians, to fi nd out about potentiality of the nursing profession to put spiritual care into practice. Little has been known about spiritual well-being, spirituality, and spiritual care perspectives among nursing students. In this study, a comparison has been made in spiritual well-being, spirituality, and spiritual care perspectives between the fi rst and fourth year baccalaureate nursing students. Materials and Methods: This is a descriptive–comparative study that was carried out among 283 nursing students. All the students were Iranians studying in the universities of Iran, Tehran, and Shahid Beheshti medical sciences. They volunteered to participate in the study. There were 105 fi rst year students and 178 fourth year students. The questionnaires used were on Spiritual Well-being (SWB) Scale, Spiritual Perspective Scale (SPS), and Nursing Spiritual Care Perspective Scale (NSCPS). The statistical analysis was performed using the SPSS software, version 10. The data were analyzed using descriptive statistics (distribution frequency, mean, and standard deviation). Mann–Whitney test was to compare each item and independent t-test to compare the mean values of two groups. Results: Regarding spiritual well-being, there were no signifi cant differences between the two groups. 98.8% of the fi rst year students and 100% of the fourth year students were in the category of moderate spiritual well-being. Neither were there any signifi cant differences between the two groups in spiritual perspective and spiritual care perspectives. Conclusions: The scores of fourth year nursing students were similar to those of fi rst year students in spiritual well-being, spirituality, and spiritual care perspectives, though the fourth year students had already undergone 4-year nursing course. Including spiritual care in the curriculum of nursing students’ courses will add to their understanding and provision of spiritual care. This will fi ll the present gap evident in the system in Iran. At present, the educational system here does not make use of spiritual care as part of its comprehensive curriculum.

The effect of lavender essential oil on anxiety level in patients undergoing coronary artery bypass graft surgery: A double-blinded randomized clinical trial.

Abstract: Background: Open heart surgery can cause high levels of anxiety in patients. Nowadays, lavender essential oil is widely used in medical research. This study was conducted with an aim to investigate the effects of lavender essential oil to reduce the anxiety of patients after coronary artery bypass surgery. Materials and Methods: This research is double-blinded randomized controlled trial on 60 patients who had undergone coronary artery bypass surgery in a 2-day intervention targeting reduction of anxiety. This study was conducted in Ekbatan Therapeutic and Educational Center, Hamadan city, Iran, in 2013. The patients in the inhalation aromatherapy group inhaled two drops of 2% lavender essential oil and those in the control group inhaled two drops of distilled water as placebo for 20 min on the 2nd and 3rd days after surgery. The level of anxiety was evaluated by Spielberger’s State Anxiety questionnaire before and after intervention and the vital signs were documented as well. Data were analyzed using Stata 11 (Stata Corp., College Station, TX, USA) by independent t-test for continuous variables and Chi-square test for categorical variables. Results: The mean score of anxiety in the aromatherapy group was 48.73 ± 5.08 and in the control group was 48 ± 6.98 before the intervention (P = 0.64), which reduced after the intervention to 42.6 ± 5.44 and 42.73 ± 7.30, respectively. On the 3rd day after surgery, the mean score of anxiety in the aromatherapy group was 46.76 ± 4.07 and in the control group was 46.53 ± 7.05 before the intervention, which reduced to 41.33 ± 3.65 and 41.56 ± 6.18, respectively, after the intervention. However, there was no statistically significant difference in the mean scores of anxiety between the aromatherapy and control groups. Conclusions: Lavender essential oil has no significant effect on anxiety in patients after coronary artery bypass surgery, although it decreased the level of anxiety in the patients. Key words: Anxiety, aromatherapy, coronary artery bypass, Iran, plant medical

Quality of life in multiple sclerosis (MS) and role of fatigue, depression, anxiety, and stress: A bicenter study from north of Iran.

Abstract: Background: Although studies have demonstrated significant negative relationships between quality of life (QOL), fatigue, and the most common psychological symptoms (depression, anxiety, stress), the main ambiguity of previous studies on QOL is in the relative importance of these predictors. Also, there is lack of adequate knowledge about the actual contribution of each of them in the prediction of QOL dimensions. Thus, the main objective of this study is to assess the role of fatigue, depression, anxiety, and stress in relation to QOL of multiple sclerosis (MS) patients. Materials and Methods: One hundred and sixty-two MS patients completed the questionnaire on demographic variables, and then they were evaluated by the Persian versions of Short-Form Health Survey Questionnaire (SF-36), Fatigue Survey Scale (FSS), and Depression, Anxiety, Stress Scale-21 (DASS-21). Data were analyzed by Pearson correlation coefficient and hierarchical regression. Results: Correlation analysis showed a significant relationship between QOL elements in SF-36 (physical component summary and mental component summary) and depression, fatigue, stress, and anxiety (P < 0.01). Hierarchical regression analysis indicated that among the predictor variables in the final step, fatigue, depression, and anxiety were identified as the physical component summary predictor variables. Anxiety was found to be the most powerful predictor variable amongst all (β = −0.46, P < 0.001). Furthermore, results have shown depression as the only significant mental component summary predictor variable (β = −0.39, P < 0.001). Conclusions: This study has highlighted the role of anxiety, fatigue, and depression in physical dimensions and the role of depression in psychological dimensions of the lives of MS patients. In addition, the findings of this study indirectly suggest that psychological interventions for reducing fatigue, depression, and anxiety can lead to improved QOL of MS patients. Key words: Anxiety, depression, fatigue, multiple sclerosis, quality of life, stress

The effectiveness of a supportive educative group intervention on family caregiver burden of patients with heart failure.

Abstract: Background: Living with heart failure patients is a complex situation for family caregivers. Few studies have been conducted to examine the effects of interventional programs to ease this condition. The purpose of this study was to determine the effectiveness of a supportive educative group intervention in reducing family caregivers’ burden of caregiving. Materials and Methods: This randomized clinical trail was conducted at a selective teaching hospital in Isfahan, Iran in 2012. The intervention consisted of four weekly multimedia training sessions of 2 h that included education and family support for 50 family caregivers. Caregiver burden was measured using the Zarit Burden Interview (ZBI). Paired t-test, Student’s t-tests, and repeated measures analysis of variance (ANOVA) were used to test for signifi cant differences of the mean scores of burden between the intervention and control groups over a 3-month period. Results: The intervention was successful in reducing caregiver burden over time both at the end of the intervention period (P = 0.000) and 3 months after the intervention (P = 0.000). Conclusions: Nurses and other healthcare providers can use the fi ndings of this study in order to implement effective programs to reduce family caregivers’ challenges and to provide them more support.

Effect of a spiritual care program on levels of anxiety in patients with leukemia

Abstract: Background: Leukemia is the most common and fatal cancer among young adults. Among all malignancies, it has the greatesteffects on emotional and mental aspects of the patients. While 25-33% of patients with non-hematological malignancies sufferfrom anxiety disorder, some studies have reported the rate among patients with leukemia as high as 50%. Anxiety can negativelyaffect other important characteristics and parameters in patients with cancer. Furthermore, cancer increases the patients’ spiritualneeds. Therefore, spirituality has a signifi cant role in adapting to leukemia and coping with its consequent mental disorders such asanxiety. This study was hence performed to determine the effects of a spiritual care program on anxiety of patients with leukemia. Materials and Methods: This randomized clinical trial was conducted in Sayyed-Al-Shohada Hospital affi liated to Isfahan Universityof Medical Sciences (Isfahan, Iran) in 2012. Sixty four adult patients with leukemia were randomly divided into the experiment andcontrol groups. The spiritual care program including supportive presence and support for religious rituals was implemented for 3 days.Anxiety subscale from the 42-item depression, anxiety and stress scale was completed before and after the intervention for bothgroups. Data was analyzed using descriptive and inferential statistical methods (Chi-square, paired and independent t-tests) in SPSS18. Results: There was no signifi cant difference between the two groups before the intervention. However, after the intervention,mean score of anxiety were signifi cantly lower in the experiment group than in the control group (P < 0.01). There was also asignifi cant difference in the scores of the experiment group before and after the intervention (P < 0.01). Such a difference wasabsent in the control group. Conclusions: Our spiritual care program could successfully decrease anxiety levels in patients with leukemia. Therefore, in casesof refractory diseases such as cancer, nurses have to apply a holistic care approach with emphasis on spiritual care. Key words: Anxiety, Iran, leukemia, nursing, spirituality

Problems and challenges of nursing students' clinical evaluation: A qualitative study.

Abstract: Background: The purpose of this qualitative exploratory study was to explore the views of nursing trainers and students about nursing students’ clinical evaluation problems and drawbacks in Shiraz Nursing and Midwifery School. Materials and Methods: A qualitative exploratory approach was used in this study at Shiraz Nursing and Midwifery School in 2012. A purposeful sample of 8 nursing instructors and 40 nursing students was interviewed and the data on their opinions about the problems of the clinical evaluation were collected through semi-structured deep interviews. Initially, four open-ended questions, which were related to the clinical evaluation status, problems, were used to stimulate discussions in the interview sessions. Content analysis was employed in order to analyze the transcribed data. The recorded interviews were initially transcribed, read, and reread on a number of occasions to get an overall feeling of what the participants were saying. Each line or incident was described, and then a code, which refl ected the essence of the participants’ comments, was given. Results: The codes were compared for similarity and differences, merged together, and categorized. Finally, fi ve themes emerged: In appropriate clinical evaluation method, problems of clinical evaluation Process, problems related to clinical instructors, unsuitable programming of clinical education, and organizational shortcomings. Conclusion: Besides focusing on upgrading the current clinical evaluation forms, nursing trainers should improve their knowledge about a complete and comprehensive clinical evaluation. They should also apply other appropriate and objective clinical evaluation methods and tools, and perform a formative and summative clinical evaluation. Also, workload adjustment of the nursing trainers needs revision. Therefore, despite using traditional and sometimes limited evaluation methods for assessing nursing students, a co mprehensive and appropriate evaluation of nursing students’ clinical competencies seems necessary.

The effect of a supportive educational program based on COPE model on caring burden and quality of life in family caregivers of women with breast cancer

Abstract: Background: The family caregivers of the people with cancer such as breast cancer experience a decrease in their quality of life and an increase of their caring burden. In most of the cases, the researchers consider the quality of life and physical and psychological problems in patients with cancer and pay less attention to the family caregivers. To reduce the caring burden imposed to the caregivers and improve their quality of life, supportive strategies such as problem solving can be used. These interventions may have benefits for the caregivers although the research results are contradictory. The aim of this research was to determine the effect of a supportive educational program, based on COPE model, which focuses on creativity, optimism, planning, and expert information on individuals, on the caring burden and quality of life in the family caregivers of women with breast cancer. Materials and Methods: The present study is a clinical trial, which was conducted in Seyed-Al-Shohada Hospital of Isfahan University of Medical Sciences and a private center of chemotherapy in 2012. In this study, researchers investigated the effect of a supportive educational program based on COPE model on the caring burden and quality of life in the family caregivers of women with breast cancer. This supportive educational program included two hospital visits and two telephone sessions based on COPE model for 9 days. A total of 64 patients were selected based on the inclusion criteria and randomly assigned into two groups. Data were collected by use of Caregiver Quality of Life Index‑Cancer (CQOL‑C), World Health Organization Quality of Life — Bref(WHOQOL-Bref)_, and Zarit caring burden at the beginning of the intervention and a month after the intervention. Results: The results showed that in the experimental group, the mean score of physical, mental, spiritual, environmental domains and overall quality of life in the family caregivers was significantly increased compared to the control group, but there was no change in the social domain of quality of life in the two groups. In the experimental group, the mean score of caring burden among the caregivers was significantly decreased compared to the control group . Conclusion: Results of the present study suggested that a supportive educational program can improve physical, mental, spiritual, environmental domains and overall quality of life. It can also decrease the caring burden in the family caregivers of women with breast cancer. Further studies are needed to evaluate the impact of these interventions on quality of life and caring burden in the family caregivers of women with breast cancer undergoing other cancer treatments.

Association between shift working and musculoskeletal symptoms among nursing personnel.

Abstract: A BSTRACT Background: Some health problems are more prevalent in shift workers than day workers. Musculoskeletal disorders are considered as one of the most common health-related problems that can cause disability among health care workers. The aim of this study was to assess the associations between shift working and the prevalence of musculoskeletal symptoms (MSs) among nursing personnel. Materials and Methods: This study was conducted among 454 health care workers including nurses and nurses’ aides in a general hospital in Iran. A Nordic musculoskeletal questionnaire was used to evaluate the prevalence of MSs. Logistic regression analysis with adjusting for confounding factors was performed to evaluate the associations between shift working and the prevalence of MSs. Results: Lower back, knees, and upper back symptoms with the prevalence of 57.4%, 48.4%, and 47%, respectively, were the most common MSs. The prevalence of MSs in eight regions of the body (lower back, neck, knees, upper back, shoulder, wrist, buttock, and ankle) was higher among shift workers than day workers. The differences were statistically signifi cant only in the lower back and ankle regions ( P < 0.05). Odds Ratio for lower back symptoms in shift workers was 1.94 compared to day workers ( P = 0.003). Conclusion: Findings of this study suggested that shift working could be associated with increased prevalence of lower back disorders among nursing personnel. This study emphasizes on the importance of proper work planning and regulating working hours for nursing personnel. Key words: Health personnel, Iran, musculoskeletal pain, nurses, nurses’ aides, work

A family support intervention to reduce stress among parents of preterm infants in neonatal intensive care unit

Abstract: Background: Preterm infants constitute a large proportion of the newborn population in the neonatal intensive care units (NICUs). Parents, as the main members of the care team, are not adequately supported as the focus is chiefly on infant care. The present study aimed to evaluate the effect of a family support intervention on the stress levels among the parents of preterm infants in NICU. Materials and Methods: In this quasi-experimental study, convenience sampling method was used to select 50 parents of preterm infants. The subjects were allocated to two groups of intervention and control (n = 25 pairs in each). While the control group received routine care, the intervention group benefitted from a two‑stage family support program (including informational and observational phases in the first stage and emotional supportive intervention in the second). The Parental Stressor Scale‑NICU (PSS‑NICU) was completed by both fathers and mothers of the two groups (before and after intervention). Descriptive and inferential statistics were employed to analyze data in SPSS version 18. Results: Before the intervention, the mean total scores of PSS-NICU and also the mean scores of its three subscales were not significantly different between the two groups. However, after the intervention, significant differences were observed between the two groups. The scores of the intervention group showed significant reduction following the intervention, but such a difference was not detected in the control group. Conclusions: Apparently, early educational and emotional support for parents of preterm infants decreased their stress. Similar interventions may thus be effective in empowering parents for caring of their infant and playing their parental role.

The effect of progressive muscle relaxation method on test anxiety in nursing students.

Abstract: Background: Concerning the prevalence of test anxiety among nursing students and presence of stress in nursing education years, this study was conducted to determine the effect of progressive muscle relaxation method on test anxiety among nursing students of Isfahan University of Medical Sciences in 2013. Materials and Methods: This was a quasi-experimental study conducted in three stages on 49 male and female nursing students divided into two groups (study and control). In the pre-test stage, demographic data and Sarason anxiety questionnaires were filled by 94 students (of terms 3 and 4). Then, in the intervention stage, the students having test anxiety were assigned to two groups (study and control), and the progressive muscle relaxation method was performed in the experiment group in four sessions. Then, the students did this method two times a day until final exams, immediately following which they filled the self-reported checklists. On the first day of the final exams, test anxiety questionnaire was filled by the two groups again. The collected data were analyzed by the statistical tests, i.e. χ2, paired t-test, independent sample t-test, Mann–Whitney and Wilcoxon tests, using SPSS 18. Results: Independent t-test showed a significant difference in the mean scores of test anxiety after intervention between the two groups of study and control (P = 0.00), but this difference was not significant before intervention (P = 0.76). Also, in the study group, there was a significant difference in the mean scores of test anxiety before and after intervention (P = 0.00), but this difference was not significant in the control group (P = 0.09). Mann–Whitney test showed no significant difference in categorization of test anxiety scores before intervention in the study and control groups (P = 0.60), but the difference was significant after intervention (P = 0.00). Wilcoxon test showed a significant difference in categorization of test anxiety scores in the study group before and after intervention (P = 0.00), but the difference was not significant in the control group (P = 0.083). Conclusions: Generally, the results showed that performing progressive muscle relaxation method was effective in reducing test anxiety among nursing students. It is suggested to conduct educational programs concerning this method in the faculties of nursing to decrease the test anxiety of nursing students. Key words: Iran, muscle relaxation, nursing, students, test anxiety

The effect of Creating Opportunities for Parent Empowerment program on maternal stress, anxiety, and participation in NICU wards in Iran

Abstract: Background: The purpose of this study was to perform the Creating Opportunities for Parent Empowerment (COPE) program for Iranian mothers and evaluate its effectiveness on stress, anxiety, and participation of mothers who have premature infants hospitalized in neonatal intensive care units (NICUs). Materials and Methods: A randomized clinical trial was conducted with 90 mothers of premature infants hospitalized in the educational neonatal NICUs of state hospitals affi liated to Isfahan University of Medical Sciences. For measuring the variables, State-Trait Anxiety Inventory, the Parental Stressor Scale: Neonatal Intensive Care, and The Index of Parental Participation/ Hospitalized Infant were used. Intervention group received two phases of COPE program. This program consisted of information and behavioral activities about the characteristics of premature infants. Sessions’ interval was from 2 to 4 days. Stress and anxiety were measured three times (before each phase and 2-4 days after the second phase). Mothers’ participation was evaluated 2-4 days after the second phase. The t-test, χ 2 , Mann-Whitney U test, and repeated measurement test were used for data analysis. Results: Mothers in the intervention group reported signifi cantly less anxiety and less stress in the NICU after performing each phase of the COPE program (P < 0.001), whereas at this time, the level of stress in the comparison group increased. Also, COPE mothers participated in their infants’ care rather than the mothers in the comparison group (P < 0.001). Conclusion: COPE program was effective for Iranian mothers. This study shows that irrespective of any culture, giving early and comprehensible educational-behavioral information may have positive effect on maternal psychological condition and maternal– infant interaction.

The effect of massage therapy on the quality of sleep in breast cancer patients.

Abstract: A bstra ct Background: Annually, about 6000 new cases are diagnosed with breast cancer in Iran. In Iran, more women are affected with breast cancer than a decade earlier in comparison with other countries, and 70% of them are diagnosed at an advanced phase. Insomnia is the most common disorder following breast cancer, and interference in sleep quality and rest causes changes in physiological functions and reduces the body’s daily performance. The objective of this study was to determine the effect of massage therapy on the quality of sleep in patients with breast cancer. Materials and Methods: This clinical trial was conducted for about 1 month in a referral chemotherapy clinic of a teaching hospital in Isfahan, Iran. The participants consisted of 57 women with breast cancer who were selected by simple random sampling. They were randomly assigned to two groups of control and experimental. The control group was treated only by usual medical therapy, whereas the case group was treated by combined medicalmassage therapy. Data collection tools were the validated Pittsburgh Sleep Quality Index and a demographic questionnaire. Data were analyzed by SPSS using descriptive statistics, Chi-square test, paired t -test, and Students t -test. Results: The results showed significant differences in the mean scores of quality of sleep before and after the intervention in the case group, while no significant differences were observed in the mean scores of quality of sleep before and after the intervention in the control group. In addition, no significant differences were observed in the mean scores of quality of sleep before the intervention between case and control groups. However, significant differences were observed in the mean scores of quality of sleep after the intervention between case and control groups. Conclusion: According to the results of this study, learning and applying massage techniques by medical staff causes health promotion and improves the quality of sleep in cancer patients. Furthermore, massage therapy is suggested as a non-pharmacologic method to improve sleep quality in these patients. Key words : Breast cancer, Iran, massage therapy, nursing, quality of sleep

Caregiver burden among Iranian heart failure family caregivers: A descriptive, exploratory, qualitative study

Abstract: Background: Living with patients of chronic diseases such as heart failure (HF) is a diffi cult situation for the caregivers. This study explored the Iranian family caregivers’ burden of caregiving for patients with HF. Materials and Methods: Eighteen family caregivers of the HF patients from two governmental medical training centers in Isfahan, Iran were recruited using purposive sampling. Data were collected through face-to-face semi-structured interviews. Each interview was transcribed verbatim and was thematically analyzed concurrently. Results: Four major themes emerged from the analysis of the transcripts: Lack of care-related knowledge, physical exhaustion, psychosocial exhaustion, and lack of support. Family caregivers believed that they have little knowledge about the patients’ disease, drugs, and how to perform caregiving roles. They experienced negative physical and psychosocial consequences of full-time and highly extended caregiving roles, such as musculoskeletal disorder, fatigue, and sleep disturbance, and a high level of anxiety, stress, and social isolation. Caregivers believed that they receive little familial and organizational support on the emotional and fi nancial dimensions of caregiving. Conclusions: The fi ndings of this study can be used by healthcare providers, especially nurses, to provide more effective social, informational, and professional support for family caregivers.

The effect of laughter Yoga on general health among nursing students

Abstract: Background: Materials and Methods: Results: Conclusions: The fi ndings showed that laughter Yoga had a positive effect on students’ general health and improved the signs of physical and sleep disorders, lowered anxiety and depression, and promoted their social function. Therefore, laughter Yoga can be used as one of the effective strategies on students’ general health. Key words: Halth , laughter, nursing students, Yoga The fi ndings showed a signi fi cant difference in the mean scores of general health before and after laughter Yoga intervention in the two groups of study and control. This is a quasi-experimental two-group three-step study conducted on 38 male nursing students in the nursing and midwifery school of Isfahan University of Medical Sciences in 2012. In the study group, eight 1 h sessions of laughter Yoga were held (two sessions a week), and in the control group, no intervention was conducted. The data of the present study were collected by Goldberg and Hiller’s General Health Questionnaire and analyzed by SPSS version 12. Promotion and provision of individuals’ health is one of the bases for development in societies. Students’ mental health is very important in each society. Students of medical sciences universities, especially nursing students, are under various stresses in clinical environment, in addition to the stress they experience in theoretical education environment. With regard to the importance of nursing students’ general health and considering the various existing strategies to promote general health components, use of complementary treatments is more considered because of their better public acceptance, low costs, and fewer complications. One of the new strategies in this regard is laughter Yoga. The present study was conducted with an aim to de fi ne the effect of laughter Yoga on general health among nursing students.

Predictors of mental health during pregnancy.

Abstract: Background: Pregnancy with anxious or depressive symptoms might be associated with worse birth outcomes The aim of this study was to determine the demographic predictors of anxiety and depression symptoms in pregnant women Materials and Methods: We assessed pregnancy anxiety and depression levels among 142 women in three trimesters All subjects completed two questionnaires: Demographic scale and the 21‑item Depression Anxiety Stress Scale (DASS‑21) questionnaire Chi‑square test and regression analysis were used to assess the association between anxiety and depression symptoms with maternal age, maternal education, family income, gestational age, body mass index, parity, and pregnancy risk Results: 253% of the pregnant women reported having depressive symptoms Also, 493% of the subjects reported having anxiety symptoms There was positive correlation between body mass index, gestational age, and pregnancy risk with depression symptom Also, there was negative correlation between family income and maternal education level with anxiety symptom In linear regression model, the variables of maternal age, maternal education, parity, abortion, gestational age, family income, body mass index, and pregnancy risk predicted 447% anxiety (F = 1903, P = 0006) and 681% depression (F = 2101, P = 0003) The strongest predictors of depression in pregnant women were pregnancy risk (β = 0361, P = 0001) and maternal education (β = −0297, P = 0006) Also, pregnancy risk (β = 0523, P = 0001) and gestational age (β = 0477, P = 001) were the important predictors of maternal anxiety in the pregnancy period Conclusions: Pregnancy risk, gestational age, and education level are the strongest predictors of mental health in the pregnancy period This result suggests that psychological support is needed for pregnant women with high risk and low education, especially in the third trimester, to improve their mental health Key words: Anxiety, depression, pregnancy

Compliance to treatment in patients with chronic illness : A concept exploration.

Abstract: Background: Patients’ compliance to treatment is an important indicator for evaluating the successful management in chronic illnesses. Despite the fact an applicable definition of compliance is required to suitable intervention and research, this concept is not clear and there is no consensus concerning its meaning, definition, and measurement. The aim of this study was to explore the concept of compliance and to formulate a working definition. Materials and Methods: Theoretical phase of Schwartz-Barcott and Kim’s Hybrid Model of concept analysis was used to analyze the concept of compliance. Data were collected by using literature reviews. Medline, CINAHL, Ovid, Elsevier, Pro Quest and Blackwell databases were searched from 1975 to 2010 using the keywords “Compliance,” “Non-compliance,” “Adherence,” and “Concordance.” Articles published in English were selected if they included adult patients with chronic illnesses and reported attributes of compliance; 23 such relevant articles were chosen. Results: The attributes of compliance included patient obedience, ability to implement medical advice, flexibility, responsibility, collaboration, participation, and persistence in implementing the advices. Antecedents are organized into two interacting categories: Internal factors refer to the patient, disease, and treatment characteristics and external factors refer to the healthcare professionals, healthcare system, and socioeconomic factors. Compliance may lead to desirable and undesirable consequences. A working definition of compliance was formulated by comparing and contrasting the existing definitions with regard to its attributes which are useful in clinical practice and research. Conclusions: This finding will be useful in clinical practice and research. But this working definition has to be tested in a clinical context and a broad view of its applicability has to be obtained.

The effect of earplugs and eye mask on patients' perceived sleep quality in intensive care unit

Abstract: Background: Sleep is one of the basic human needs and sleep deprivation causes numerous undesirable effects on the human body and mind, especially in the intensive care unit (ICU) patients. It seems that noise and light are important environmental factors interrupting sleep in these patients. This study was carried out to determine the effect of earplugs and eye mask on Iranian patients’ sleep quality in ICU. Materials and Methods: In this cross-over clinical trial, 50 patients in the ICUs of Al-zahra Medical Center in Isfahan in 2012 were selected by convenient sampling method and randomly assigned to two groups. In group A, patients wore earplugs and eye mask in the fi rst night during their sleep and slept without earplugs and eye mask in the second night, and the intervention was conversely conducted in group B. Verran and Snyder-Halpern Sleep Scales were used to measure the patients’ sleep quality. The data were analyzed by paired t-test, independent t-test, one-sample t-test, and one-way analysis of variance (ANOVA) through SPSS version 18. Results: Effect of the intervention on sleep effectiveness was positive, and there were signifi cant differences (P < 0.001) between treatment night and control night, and also within each group (P < 0.001). Effect of the interventions on sleep disturbance was positive, and there was a signifi cant difference at treatment night compared to the control night between groups and within each group (P < 0.001). Also, the mean scores for sleep supplementation were measured after the second night, and the results showed the scores signifi cantly increased in the intervention group compared to the control group (P < 0.001, ER = 47, F = 22.1). In addition, carryover effects for sleep effi ciency and sleep disturbance were positive, but periodic effects for sleep effi ciency and sleep disturbance were negative and positive, respectively. Conclusions: Although wearing earplugs and eye mask is a cost-effective and safe method and can improve perceived sleep quality in ICU patients, further research is needed to demonstrate the effect of this method.

Clinical concept mapping: Does it improve discipline-based critical thinking of nursing students?

Abstract: Background: Enhancing nursing students’ critical thinking is a challenge faced by nurse educators. This study aimed at determining the effect of clinical concept mapping on discipline-based critical thinking of nursing students. Materials and Methods: In this quasi-experimental post-test only design, a convenient sample of 4 th year nursing students (N = 32) participated. They were randomly divided into two groups. The experimental group participated in a 1-day workshop on clinical concept mapping. They were also assigned to use at least two clinical concepts mapping during their clinical practice. Post-test was done using a specially designed package consisting of vignettes for measurement of 17 dimensions of critical thinking in nursing under two categories of cognitive critical thinking skills and habits of mind. They were required to write about how they would use a designated critical thinking skills or habits of mind to accomplish the nursing actions. The students’ responses were evaluated based on identifi cation of critical thinking, justifi cation, and quality of the student’s response. The mean score of both groups was compared by Mann-Whitney test using SPSS version 16.5. Results: The results of the study revealed a signifi cant difference between the two groups’ critical thinking regarding identifi cation, justifi cation, and quality of responses, and overall critical thinking scores, cognitive thinking skills, and habits of mind. The two groups also differed signifi cantly from each other in 11 out of 17 dimensions of critical thinking. Conclusion: Clinical concept mapping is a valuable strategy for improvement of critical thinking of nursing students. However, further studies are recommended to generalize this result to nursing students in their earlier stage of education.

Nurses' policy infl uence: A concept analysis

Abstract: Background: Nurses’ infl uence on health policy protects the quality of care by access to required recourses and opportunities. This is a new and important concept for nursing; however, research studies on policy infl uence of nurses in health care sector are lacking a basic conceptual understanding of what this concept represents. The aim of this paper is to clarify the concept of nurses’ policy infl uence and to propose the defi nition of this concept, considering the context of Iran. Materials and Methods: The eight stages of Walker and Avant approach was used to guide this concept analysis. Various databases and internet engines were searched to fi nd all related information about the concept. Textbooks were also searched manually. English language literature reports published between 1990 and 2012 were reviewed. Results: Based on the analysis undertaken, nurses’ policy infl uence is nurses’ ability in infl uencing decisions and affairs related to health through political knowledge, effective communication, and collaboration with other members of the health team, which results in the improvement of nurses’ job environment and increases patient outcomes. This is a dynamic process situated on a spectrum and is accompanied with nurses’ knowledge, competency, power, and advocacy, and also their ability to change. Conclusions: Nurses have individual views on health care issues and infl uence health care policies in different ways. With a common understanding of nurses’ policy infl uence as a concept, nurses will recognize the importance of policy making in the health sector and their infl uence on this process and also on patients’ outcomes.

Experiences of the families concerning organ donation of a family member with brain death

Abstract: Background: In recent years, the lack of organ for transplantation has resulted in health planners and authorities in all countries, including Iran, paying serious attention to the issue Despite the above-mentioned fact, families with a member affected by brain death are not interested in organ donation Objective: This study is aimed at making an investigation into the decision-making process of organ donation in families with brain death Also, the research is aimed at investigating how the deterrent and facilitating factors in the process of organ donation can be made Materials and Methods: The current research is a qualitative study with descriptive exploratory approach Data were collected through unstructured interviews with 10 family members who gave consent to organ donation of their family members in 2012 Purposeful sampling processes began in March 2012 and lasted up to June 2012 Simultaneously, thematic approach was used in analyzing the data Results: Data analysis led to fi nding 24 categories and 11 themes, which fell into two categories: facilitating and deterrent factors The fi ve main deterrent themes included the fi ve themes of prohibiting factors that were shock, hope for recovery, unknown process, and confl ict of opinions, and worrying association The six main facilitating themes included humanistic desires, immortality, culture making, satisfaction of the deceased, assurance, and eternal honor Conclusion: The fi ndings indicated that there is ambiguity and different interpretations on brain death The research also showed that using the experiences of donator families can provide practical and applied solutions to facilitate the process of organ donation and solve the problems faced by the health care system

Challenges of children with cancer and their mothers: A qualitative research

Abstract: Background: Cancer is one of the major causes of death in children and adolescents. About 4% of deaths in children of age less than 5 years and 13% of deaths in children of age 5-15 years are due to cancer in Iranian population. The disease can cause many problems, which are usually detected by a psychologist, for the children and their mothers. Therefore, this study aimed to identify the psychological challenges of the children with cancer and their mothers’ experience. Materials and Methods: This is a qualitative research conducted through thematic analysis approach. Semi-structured interviews were used to collect the data. Purposive sampling was conducted. The numbers of the children and their mothers participating in this study were 34 and 32, respectively. Results: Data analysis showed that the problems faced by children with cancer and their mothers fell into five main categories. These categories included spiritual, psychological (such as aggression, anxiety, depression), communicational problems, inadequate knowledge (about the disease, its treatment, and treatment complications), and care-related problems. Conclusions: The results showed that lack of awareness and spiritual problems were the most important problems of the patients and their mothers. If necessary knowledge about the disease and its treatment and complications is given to the children and their mothers at the time of diagnosis, and also, spiritual care interventions are administered during treatment, their psychological problems can be notably reduced.

Workplace bullying in nursing: The case of Azerbaijan province, Iran

Abstract: Background: Workplace bullying is a significant issue confronting the nursing profession both in Iran and internationally. This study examined workplace bullying among a group of Iranian nurses. Materials and Methods: The prevalence rate of bullying behavior among nurses was determined. Data were collected from 162 nurses who worked in four hospitals located in West Azerbaijan province, Iran. Results: Results showed that only 9% of nurses who participated in this study had frequently been exposed to bullying behavior, 22% had occasionally been bullied, and 69% had never been exposed to these behaviors during the last year. The most common type of workplace bullying experienced by nurses was verbal bullying. Forty percent of the nurses reported exposure to verbal bullying behavior frequently or occasionally. Conclusions: To be able to intervene with bullying behavior in the workplace, there is a need to pay greater attention to the problem by the entire range of managers, lawyers, industrial–organizational psychologists, counselors, social workers, and local authorities. Key words: Iran, nursing, workplace bullying

Influencing factors on professional commitment in Iranian nurses: A qualitative study.

Abstract: A BSTRACT Background: Dissatisfaction and tending to leave are some of the major nursing problems around the world. Professional commitment is a key factor in attracting and keeping the nurses in their profession. Commitment is a cultural dependent variable. Some organizational and socio-cultural factors are counted as the drivers of professional commitment. This study aimed to explore factors infl uencing the professional commitment in Iranian nurses. Materials and Methods: A qualitative content analysis was used to obtain rich data. We performed 21 in-depth face-to-face semi-structured interviews. The sampling was based on the maximum variation with the staff nurses and managers in 5 university affi liated hospitals. Constant comparative method used for data analysis Results: Two main categories were emerged: “Challenging with different feelings” and “Managers’ role”. Challenging with different feelings had two subcategories: “Burnout” and “sense of valuing”. The other theme was composed of three subcategories: “Gratitude or punishment climate”, “manager’s view of caring” and “knowledge-based vs. routine-based nursing”. Conclusions: Findings revealed the burnout as a common sense in nurses. They also sensed being valued because of having a chance to help others. Impediments in the health care system such as work overload and having more concern in the benefi ts of organization rather than patient’s care and wellbeing lead to a sense of humiliation and frustration. Congruence between the managers and nurses’ perceived values of the profession would be a main driver to the professional commitment. Making a sense of support and gratitude, valuing the care and promoting the knowledge-based practice were among the other important factors for making the professional commitment. Key words: Commitment, Iran, nurses, qualitative research

Parents’ participation in taking care of hospitalized children: A concept analysis with hybrid model

Abstract: A bstra ct Background: Although today parents’ participation in taking care of hospitalized children is considered as an indispensable principle, it is still among the concepts with no consensus about. The main objective of this study is to define parents’ participation in taking care of hospitalized children. Materials and Methods: The concept of “parents’ participation in taking care of hospitalized children” was analyzed using a hybrid model in three phases: Literature review (theoretical phase), fieldwork, and combination of literature review and fieldwork (analytical phase). Results: Based on the results of theoretical (literature review), fieldwork, and analytical phases, the best definitions for the concept Conclusions: The findings of this study showed that the dimensions of parents’ participation can be applied in pediatric wards, and nurses can improve the quality of care through application of the obtained findings.

Comparison of the effect of aromatherapy with Jasminum officinale and Salvia officinale on pain severity and labor outcome in nulliparous women.

Abstract: Background: Using non-pharmacological pain relief methods for reducing labor pain has always been one of the major concerns in obstetrics and gynecology. Objective: Comparing the effects of aromatherapy with jasmine and salvia on pain severity and labor outcome in nulliparous women. Materials and Methods: In this randomized clinical trial, 156 nulliparous women in labor were randomly selected and divided into salvia, jasmine, and control groups (52 in each group). The study duration was 6 months (from October 2009 to March 2010). Each group underwent aromatherapy using an incense mask for 15 min (distilled water for the control group). Pain severity was measured before and 30 and 60 min after the incense aromatherapy. Also, duration of the first and second stages of labor, first- and fifth-minute APGAR scores of the baby, and the frequency of labor type were measured and recorded in each group. Results: In comparison to the other groups, pain severity and duration of the first and second stages of labor were significantly lower in the aromatherapy group of salvia 30 min after the intervention (P = 0.001). However, no significant difference was found among the three groups regarding pain severity 60 min after the aromatherapy, first- and fifth-minute APGAR scores of the baby, and the frequency of labor type. Conclusions: The results of the present study indicated that aromatherapy with saliva had beneficial effects on pain relief, shortened the labor stages, and had no negative impact on the baby’s APGAR score. Key words: Aromatherapy, Jasminum officinale, labor, nulliparous, Salvia officinale 1Department of

An educational intervention to improve nurses’ knowledge, attitude, and practice toward reporting of adverse drug reactions

Abstract: Background: The reporting of adverse drug reactions (ADRs) by nurses in hospitals is very important. Aims: This study was aimed at investigating the impact of an educational intervention to improve ADR reporting and whether trained nurses had better knowledge, attitude, and practice toward ADR reporting. Materials and Methods: A total of 300 nurses in a tertiary care teaching hospital in Tehran, Iran were evaluated with a knowledge, attitude, and practice (KAP) questionnaire regarding ADR reporting in March 2010. After this, an educational program about ADR was provided to nurses. Then the nurses were re-evaluated by the same questionnaire. Comparisons were made of the attitude and knowledge within nurses, before and after education. Data were analyzed using SPSS software. P < 0.05 was considered as signifi cant level. Independent-sample t-test was used to measure the intervention effect. Results: The response rate was 61.3% (N = 184). Knowledge of nurses before the intervention was signifi cantly less than the knowledge after the intervention (P = 0.001). Also, there was a signifi cant effect on attitude (P = 0.002). During the follow-up period of 4 months after the intervention, 26 spontaneous reports were received. Conclusion: Continuous ADR educational program, training, and integration of ADRs’ reporting into the activities of the nurses would likely improve ADR reporting.

The effect of pre-warmed intravenous fluids on prevention of intraoperative hypothermia in cesarean section

Abstract: Background: Hypothermia is one of the problems occurring during surgery, which can happen due to thermoregulation mechanism isorders and intake of low temperature IV fl uids, and may cause increase in blood pressure, heart rate, intracranial pressure,oxygen consumption, pain, and discomfort to the patient. The rate of esarean section in our country is three times more than the global standard. As one of the responsibilities of the nurse is patient’s advocacy, s/he should support them. This study aimed to investigate the effect of pre-warmed intravenous fl uids on prevention of hypothermia during general anesthesia in cesarean section. Materials and Methods: Sixty-two women undergoing elective cesarean section by general anesthesia were randomly allocated in two groups of intervention and control. Women in the intervention group received pre-warmed serum (37°C) while those in the control group received serum at room temperature (25.5°C). The core body temperature and some hemodynamic parameters of the participants were assessed during the operation. Conclusion: Infusion of pre-warmed serum (37°C) would prevent intraoperative hypothermia and improve the nursing care for women who undergo cesarean section by general anesthesia. Key words: Cesarean, hypothermia, intravenous f uids, Iran, nursing care